Stigma and mental health

Stigma happens when someone is labelled in a way that hurts their standing in the community, and encourages people to consider them as less than a whole person. Stigma is a result of ignorance: people tend to fear what they do not understand. Stigma can lead to hurt, rejection and prejudice against people who are labelled. People with mental health problems are labelled with a variety of names (e.g. as lunatics, nutters, bonkers, weak, violent, mad, failures). Many people we talked to felt shame about their mental health problems, which some of their families also felt. Some tried to overcome this shame.

Is a divorcee who is currently on Cipramil (60mg/day). She has had dysthymia and bouts of depression throughout her life, yet she has only been diagnosed recently. (Played by an actor.)

But I can't talk to my family about it. They don't know about the therapy. I think it's the stigma thing. I think it's the... I'm the youngest of a big family and I think I would be seen, my perception is that I would be seen as weak and not coping, so it's easier for me not to admit to that weakness and just say, oh, just fudge the issue really. I could never dream of saying to my family that I was seeing a psychiatrist. I mean that would be you know, horrendous. Because they wouldn't understand, certainly where I am now, the position I'm in now that it is actually a good thing. Whereas if I said I'm seeing a gastro-enterologist - fine, no problem, but seeing a psychiatrist that's it, there's something deeply wrong with you. So I've chosen to keep that from my family, and living on my own I can do that to a certain extent.

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Profile Info

Age at interview:

44

Sex:

Female

Age at diagnosis:

41

Background:

A married health care professional, with 4 children. Has probably suffered since her teens. She experiences mainly depressive episodes with some euphoria in-between.

I think that my mother had very similar experience to myself. She had, you know, I remember these highs and lows that she had. And I remember a couple of cases where she had you know a depressive, depressed period where she actually was on antidepressants. She didn't like taking them. She was ashamed of her depression, and she stopped taking them probably far too early, but you know this was just a period where I was in my probably late teens, early twenties. But then unfortunately she died shortly after that, so it's difficult to follow that through.

And I suppose she wasn't seeing the real me in the short periods that we had together by that stage, because I had left home and was only coming back for a few days at a time. But whether you... she didn't see her depression as being a chronic illness. I'm not sure, I... part of me thinks that I am better at recognising it in others now. I sometimes see it in patients that are exhibiting maybe those early signs of what could be clinical depression that I might have missed before or given another reason for. But there is a familial link and I don't know if there is, but if there is a familial link you know I would hope that I would be more aware of how they are dealing with things in general. And maybe how I could help them if indeed they became like that. I think, I have a much more open relationship I think with my children now than I ever had with my own mother.

People showed enormous courage in coping with depression and overcoming stigma and talked about how they “walked through the minefield of stigma”, while trying to feel OK about themselves. For instance, many tried to pass as 'normal' and as if they were coping. Some avoided getting a diagnosis, or wondered if they should declare their depression to potential employers, aware that a history of mental illness would make it harder to get a job. Some people argued that the effectiveness of their medication proved that the problem was with brain chemistry, was no-one's 'fault' and therefore should not be stigmatised.

Works as a receptionist. She had a difficult childhood. She has been sectioned in the past, been on numerous medications, and had ECT (Eletroconvulsive Therapy) which she did not like. (Played by an actor.)

Well, I don't feel ashamed because I educated myself. If I stayed in the family circle and not talked to a therapist, not got help really, then perhaps I would feel ashamed. Sometimes I think it was all my fault... but on the whole I think it wasn't my fault.... I was labelled with, like being psychotic. I was on psychotic drugs for a number of years. And the fact that I felt so ashamed was because it was written in black and white that I was psychotic.

It was like saying... they may have well have said I was a mad woman. We all have different experiences and different realities at different times. Feelings are fluid. They come and go and we experience them for a reason. There is nothing ever to be ashamed about with mental health. You know, there really isn't. I would really like to change the public's perception of mental health problems and depression because people sometimes, you know, they would want to say well what's the matter, what's the matter with you? It's like you can't sum it up in a sentence, what's the matter.... you know. I've spent a year in therapy and I still don't know what the matter is, I haven't got to the bottom of what's the matter with me. It takes time, you know. It takes discovery and it takes courage and it takes persistence and energy.

As people came to better accept themselves, they sometimes took a more active approach to tackling stigma. Telling a few trusted individuals is often a first step. Prejudice could not always be avoided and people sometimes ended up feeling hurt and angry at assumptions that people with mental health problems are violent, dangerous or drug addicts.

A computer programmer, married with children, who has had a number of episodes of depression, the most recent was very severe. (Played by an actor.)

And depression, albeit it is still stigmatised I think.... Is less stigmatised among young people that it was... You should tell someone now, it doesn't have to be the doctor or a therapist, it can be a friend you know. The older I've got, the more I've found that it's acceptable to say to people, "I'm depressed at the moment," and they know what it means. And you don't want them telling everyone, and there's me as the great sort of I don't know you know I tend to preach the gospel of, 'Hey depression is no different from anything else, blah, blah, blah...' and I do believe that. And you know, you wouldn't make a secret of it if it were a diabetic would you.... Hang on, actually you would, you wouldn't want to go tell everyone, but you wouldn't mind telling your best friend who you can trust, "Look I feel shit and I really think I'm depressed and I need some help.

Some people challenge other people's views on mental health very directly or even make personal complaints to the media about stereotyped portrayals of mental illness. And things are slowly changing. One man noted with relief the community outrage that occurred when a tabloid newspaper depicted Frank Bruno (the celebrity boxer) as “bonkers”. However, for another man, the Bruno episode exposed racial stereotypes on top of stigma. Others were encouraged by the way celebrities were more and more open about their depression. One man spoke positively about an anti-discrimination campaign that was run in his community, and another woman encouraged fellow users to tackle stigma directly in the media.

Working as a PA, survived an abusive father and complicit mother. Left home at 18 and was taken in by a caring Irish family. Has suffered severe bouts of depression and suicidal urges.

"Why have you been off work?" And I went, "I've been in hospital." "Oh, are you alright?" "Yeah, I'm fine thanks yes, thanks for asking." "Um, nothing too serious I hope?" "Mmm, yeah it was, but I'm ok, I'm dealing with it, thanks for asking." And they went, "Oh, oh wh- what was it then?" you know what people are like, they will try and get it out of you, and I think if you try to hide it gives them something to use against you. So I was just really outright, and I just said, "Ok, I was in a psychiatric hospital for a month and then outpatients for a further month and now I'm at work part-time to try and get back into the swing of things slowly." And he just looked at me. "I've suffered with it most of my life, and I'm just dealing with it now." And I.... honestly he, his eyes were just, popping out of his head. His jaw hit the floor, and he just didn't know what to say to me.

So he touched my shoulder and I said, "It's ok though," I said, "I'm not loopy" and he just started laughing, because I'd just turned it into a joke. You know, I'd sort of was like quite light hearted about it. I said, "It's ok, I'm not loopy, haven't lost my marbles yet. It'll take more than a bit of depression to get rid of me." And you know he was just like, "Oh my God," and I said, "Well," I said, "you've probably got all sorts of questions going through your mind right now, but if you want to know a bit about it, and about what it consists of I'll tell you."

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Profile Info

Age at interview:

55

Sex:

Male

Age at diagnosis:

51

Background:

Has two grown children and a new partner with a 12y/o son. He suffered a manic episode in 2000 at a time he was a 'workaholic' and life seemed out of control. He went into hospital voluntarily.

I think that lobby groups are tending to change things because we had an issue with Frank Bruno. You heard the story that there where a lot of people who bombarded the Sun newspaper with e-mails saying, "You know it's not acceptable to talk about 'bonkers' nowadays, and you know, the attitude, do you realise you're actually offending twenty-five percent of your readership"? [Laugh]. Effectively you know, if you think about it. So you know that kind of there's more sort of pressure perhaps to stop people being, well to get people to be a little bit more... I don't really like "politically correct" but that sort of thing you know. And there's various taboos, you can't be sexist, you can't be racist you can't be ageism or you can be a little bit ageist but you know it's getting that way. But you can still talk about nutters and psychos and so on. And so it's getting to a stage where those sort of words as well you know, what do you mean by that when you use that word you know?

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Profile Info

Age at interview:

45

Sex:

Male

Age at diagnosis:

32

Background:

Is a black gay artist, living with his partner. A difficult family life, he thought about suicide at the age of 14 and again when he had depression at 32.

Frank Bruno is a very complicated case for me because he's, for me he occurs as this sort of lovable buffoon and he is... I think he has ultimately been quite astute up until recently in handling his own image... You know, the big black bruiser with a dodgy background, boxing champion of dubious talents but somehow he's managed to find a place in the English affections. But to do that he's had to become utterly emasculated.

And its interesting... its as if he's you know come home to, he's reverted to type by being mentally unstable and uncontrollable, its almost a relief.... Certainly you know for the mainstream consciousness to know that he still is a big black male and can be out of control.... And in that capacity of course he was showered with all sorts of attention and, and I don't think altogether an un-genuine sense of affection, but he's comfortable, Frank Bruno is easy because ultimately he's harmless, he's made sure that he doesn't offer any threat...

But if you are any minority member, its not just race you know.... sexuality and a load of other things and of course women, you know if you are prepared to play the game that keeps essentially white middle class males unthreatened then you are very welcome, you will be embraced. But if you are going to express anything about the real nature of your experience at the hands of their rather odd views they're down like a pack of wolves and you know they're gonna deal with you in one way or another - albeit very civilised of course.

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Profile Info

Age at interview:

45

Sex:

Male

Age at diagnosis:

45

Background:

An athletic 45 year old man who was originally born in Brazil, now living with his partner in London. His most recent episode of depression started in late 2002 and was triggered by workplace pressure.

I think in England you still can be labelled, you know I think mental illness in England you still have the kind of stigma. But I deal with this much better I think, because in Brazilian culture it... I grew up with people seeing psychoanalysts and having nervous breakdowns you know, because one dies or whatever. But funnily enough, if you read the newspaper, you see all these artists, having breakdowns, and it's okay and it's almost as if they're not humans or we are not.... God knows what, the distinction we make between them and us.

But you know, I think even Beckham, the other day it was in the newspaper that he had or was about to have a nervous breakdown last year, blah, blah, blah and I said, "Oh good," you know, I even find I think it's really good that someone like him that is a football player blah, blah, blah goes and say, "I was about to, you know, stop playing for Manchester because of the pressure and this and that," because it breaks this assumption that depression is an illness for women or illness for weaker people. It's not, you know anyone can get depression.

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Profile Info

Age at interview:

39

Sex:

Female

Age at diagnosis:

18

Background:

Carrie Thomas is a Media Trainer living in London. There is a history of mental illness in her family. Her bipolar disorder began while studying at Oxford University.

Explode it (stigma) whenever you can I say, but I've been very out because I've campaigned a lot on this. There's also, there's and extremely useful charity called Mental Health Media, and they train, and I've actually did a bit of some of their training. They will train service users on how to face the media. If they want to go and talk to the papers say about a new service in their area, or there's been some bad press or something and they want to give their side of the story. Or want to, to give their case history or whatever, you know as an example.

Mental Health Media trains people on how to do interview on radio, TV and for the press. They've just started a new tool kit to try and tackle stigma and discrimination, and they're training people around the country at the moment on how to respond if you face stigma and discrimination. And they also have a wonderful award ceremony each year at BAFTA called the Mental Health Media Awards, and the best radio documentary, radio drama, tv drama, tv soap, website and various other..... There, basically, it's like an award ceremony and they'll, you know there might be four different clips from soaps, and you decide which one best expresses and best, honestly pursues a mental health issue, and that informs an audience well, as well as providing good drama.